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Wednesday, March 26, 2014

Vapor, vapor everywhere, and if you drop you clink! The e-cigarette saga.

I was returning from a working week in Helsinki this weekend, and stayed overnight at an airport hotel after arriving in the US. Usually a quiet place, this time the hotel was filled with countless jovial conventioneers. From their appearance, dress, and behavior, I assumed I had landed in a bikers' or NASCAR convention. But no, this was the National Vapor Club meeting.

Vapor club? What the heck is a vapor club, I asked myself? It turns out it's the devotees of the exotic new industry of e-cigarettes and e-smoking. At every table in the restaurant (except mine, I swear!) there were groups of people puffing away on their fancy, silvery devices, everyone different. They look like high-class bongs. Indeed, as one guy sat down at his table, he carefully placed two of them in front of him, to 'smoke' alternately At each table, people were puffing away, exhaling clouds of 'smoke' (presumably, just water vapor). But one could see the uncomfortable looks on the wait-staff's faces, since this was a smoke-free restaurant! Should they, could they, turn away all that business? Indeed, recent stories on the media have said that some restaurants are banning these devices. But what is 'smoking' in this context?

Puffing as jewelry!

It was such a strange experience to see the dreamy looks in the diners' eyes, not as they gazed at the babe or hunk sitting across from them, at the table but as they, one might say, stroked their thing and then sucked in the satisfying stimulant from it!

These are not paper-covered metal tubes made to look like your ordinary Marlboro. If you drop it, you don't set the table cloth or rug on fire, but you clink! And their weight must make the tactile experience more cigar-like than a cool drag on a Camel.

One can't be surprised that as actual cigarettes finally were shown to enough people to be slow killers, many who could manage it would switch to these nicotine injecting devices. At first, they seemed to be designed to look like cigarettes, with a glowing false ash tip a slender white tubular shape and all that. But then the tattoo artists or whoever got the idea that this could be jewelry as well. Status symbols with all sorts of designs and shapes have resulted, in an apparently booming market.

Now I don't know anything about the National Vapor Club, but their demeanor and t-shirts and so on suggested that this is not just a hobby group (like bikers or NASCAR fans) but an advocacy organization as well. Perhaps they are paid to proselytize or just do it for their own psychological satisfaction of being on the vanguard of something new.

If I may take the liberty of making an amateur sociological reflection in this context, this does seem largely like a social
class phenomenon--an in-your-face to the professor/liberal know-it-alls who banned real tobacco from
public use and made its addicts suffer the rain and cold to get their hits out doors. At least, the proverbial upper 1%ers were not apparent at this
Vapor Club meeting. In the old days, the Elite smokers had silver
cigarette holders, cigarette or snuff boxes, and fancy lighters. You see that in all the Edwardian period dramas. The
ordinary Joe just had an unfiltered Camel dangling between his
lips, in a way a status symbol for that class. If the Elite have been weaned off tobacco by now, perhaps these new fancy silver tubes will be a symbol of a different social class or solidarity, like tattoos
have been, perhaps.

After I had written a draft of this post, Monday's Times had a story consistent with this thinking: that smoking itself has become the purview of the poor. But if the wealthy discover this, and start making
diamond-studded e-cigs, then who knows how the social aspects will play
out.

One great idea that has been heavily promoted is that e-cigs are a good way to quit smoking combustible cigarettes, a safe way to dose up on nicotine, avoiding the diverse toxins that clobber your lungs and other organs, and those of your spouse or cohabiting kids who breathe your second-hand exhaust. With vapers, the exhaust is just harmless steam with visual but no real physiological purpose, and the main thing is that you get some purportedly safe nicotine in your lungs, plus the physical oral and psychological satisfaction that cigarette smokers get from their habit. A piece in this week's Nature argues that e-substitutes don't aid in quitting, however. They are just a new way to feed the addiction, a fact of course not unknown to the e-manufacturers.

Enter the digital age!
A long-time friend of ours is Robert Proctor, a historian at Stanford (previously here at Penn State), who is one of the foremost and most tenacious scholars who in books (especially see Golden Holocaust), papers, and court testimony has taken the tobacco industry to task for its misrepresentations and tactics to lure people to smoke even knowing (though for a long time not admitting) that their product was a killer. Robert quipped in a message to me that old-time cigarettes were simple old-fashioned analog devices, but these new e-cigs are digital! Welcome to the computer age--these new smokes are scientific and, therefore, must be good for you....right?

Well, not necessarily. The public health community, ever eager for something else to get grants to study, has jumped on the e-cigs and warned that they may have harmful effects that we don't yet know about--and that, at least, the industry should be regulated and standardized. In the absence of much actual evidence, this seemed like researcher overkill, another way to grab public funds to do yet another survey research study.

But, in the Monday NY Times there was a story that suggests there may actually be at least some evidence for harmfulness, of at least an indirect way. This may open the floodgates on this topic, such as an editorial in the March 25 Times, and the piece in Nature that both deal with this. It has the feeling of yet another science bandwagon. When you see such a flurry, you have to be wary about them, whether in the media or journals, since there is so much opportunism afoot these days.

But the main issue, that does seem to be real, is that the nicotine solutions used to refill these silver bongs may not be pure or of standardized quality and, much worse, tempt children with their colorful containers to drink the the tasty contents which contain nicotine at potentially toxic concentrations plus various sweeteners and flavors: just as Starbuck's no longer just sells actual coffee, unless you gussy it up with candy, I guess e-cigarette smokers want a flavor treat as well as a kick. Kids may not realize and may drink the alluringly packaged fluid. This could just be the research industry making up a problem to study, but apparently there are now disturbing data on children showing up in emergency rooms with toxic nicotine doses and even some fatalities; so it's a legitimate serious issue.

Might there be other toxins of various kinds lurking in these devices or other indirect risks of this new habit, besides nicotine poisoning? There is a burgeoning industry making these devices, so we may face yet another regulatory problem. If so, safety and regulation will clearly be important, and we will need some research--hopefully more definitive than most of epidemiological studies are these days.

Or, could it largely be anti-smoking purists doing some sabre-rattling because they resent the vapers, who were just defeated over real cigs, doing an e-vading end-run around the public health establishment? Maybe we should just let the vapers have their pleasures. At least, we should hold any new studies to a high standard of actual fact, and make sure any research they do is worth the funding and not just made up as professor welfare. Time will tell.

Meanwhile, the experience of being surrounded by people puffing away on thick, silvery sticks was strange!

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